Provider Demographics
NPI:1548409717
Name:LATIMER, ZACHARY NATHANIAL (PA-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:NATHANIAL
Last Name:LATIMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 TRUMBULL CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1769
Mailing Address - Country:US
Mailing Address - Phone:540-819-3760
Mailing Address - Fax:
Practice Address - Street 1:330 BORTHWICK AVE STE 107
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7110
Practice Address - Country:US
Practice Address - Phone:603-570-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053466363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical